Comprehensive Analysis of Prognostic Factors Affecting Postoperative Mortality in Adult Patients Undergoing Lower Extremity Amputation due to Diabetic Foot Ulcer

Aim:Mortality is significantly increased in patients undergoing amputation for diabetic foot ulcers (DFUs). The new biomarkers prognostic nutritional index (PNI), C-reactive protein (CRP)/albumin ratio, and comorbidities may help predict prognosis. This study aimed to determine the factors affecting mortality in DFU patients undergoing amputation.Methods:This study is a retrospective case series of patients who underwent lower extremity amputation due to DFU between 2016 and 2018. Data on demographics, clinical information, laboratory test results, comorbidities, hospital stays, re-amputations, and complications were recorded. PNI was calculated using serum albumin concentration and lymphocyte count.Results:A total of 97 patients (21 females and 76 males) were analyzed in the study, with 18 patients having bilateral lower extremity amputations (foot amputation, below-knee amputation, and above-knee amputation). The mean age was 64.48 years, and the mean follow-up period was 34.27 months. The mean length of hospital stay was 19.09 days, with a mean of 1.34 days spent in the intensive care unit. Preoperative laboratory test results showed a mean creatinine level of 1.4 mg/dL, a urea level of 55.22 mg/dL, an albumin level of 2.8 g/L, and a fasting blood glucose level of 168.8 mg/dL. The mean preoperative PNI was 39.31, and the mean CRP/albumin ratio was 42.51. Intensive care unit admission, CRP/albumin ratio, and CRP levels significantly affect 1-year postoperative mortality. The cut-off value for CRP as determined by receiver operating characteristic analysis was 89.9 mg/L. No significant association was found between comorbidities and mortality.Conclusion:We demonstrated that comorbidities and the new biomarker PNI did not affect mortality. CRP levels, intensive care unit admission, and the new predictor CRP/albumin ratio significantly affected 1-year mortality

C-reactive Protein Level, Admission to Intensive Care Unit, and High American Society of Anesthesiologists Score Affect Early and Late Postoperative Mortality in Geriatric Patients with Hip Fracture.

PURPOSE: The main purpose of this study is to evaluate prognostic factors that affected the patients' early (<30 days) and late (six months, one year, and overall) postoperative mortality following hip fracture surgery. MATERIALS AND METHODS: This retrospective study included 515 patients older than 75 years old with surgically treated osteoporotic hip fracture. The demographic data, American Society of Anesthesiologists (ASA) classification, type of anesthesia, duration of hospital stay, and history of intensive care unit (ICU) stay were collected. An analysis of laboratory values was also performed to determine their relationship with mortality. The primary outcome was survival, determined as the time from the surgery to death or the end of the study. The patients were divided into four groups according to survival time: at the first month, six months, first year, and overall survival. An analysis of demographic and laboratory values was performed to determine their validity as prognostic factors for each group. RESULTS: Postoperative C-reactive protein (CRP) level showed an independent association with a poor survival at the first month. ASA classification, admission to the ICU, and preoperative CRP levels showed an independent association with a poor survival for the first six months. Preoperative CRP level showed an independent association with a poor survival for the first year. ASA classification, admission to the ICU, and the preoperative CRP levels showed an independent association with a poor overall survival. CONCLUSION: CRP level, a high ASA classification, and postoperative ICU admission were related to poorer overall survival rate following hip fracture surgery in the elderly

Prognostic Role of Current Nutritional Indicators on Early and Late Postoperative Survival After Geriatric Hip Fracture Surgery

Aim: Malnutrition is reported to be related to higher mortality rates following geriatric hip fracture, and new malnutrition indicators are currently being identified. The aim of this study is to analyze prognostic nutritional index (PNI), C-reactive protein (CRP)/albumin ratio (CAR) and CRPI/PNI ratio (CPR) as prognostic factors for first-month, six-month, one-year and overall mortality following hip fracture surgery